Health

Classification of endometrial cells on cervical cytology

Article Abstract:

The Papanicolaou (Pap) smear is a diagnostic test to detect cervical cancer, and cells removed from the cervix are usually screened for cervical disease. However, endometrial cells (from the uterine lining) may also be present, and may be either normal or atypical. The probability of finding such cells changes according to a woman's menopausal status. For instance, the presence of endometrial cells during the first 12 days of the menstrual cycle is not associated with pathology. However, in the latter phase of the cycle, or in postmenopausal women, such cells can indicate disease. To learn more about the significance of endometrial cells in Pap smears, a retrospective review was conducted of 188 medical charts of women with endometrial cells in their smears. Approximately two-thirds were postmenopausal. The patients underwent endometrial biopsy and/or hysterectomy (removal of the uterus) in the year after their Pap smears. The study focused on documenting the endometrial cell characteristics in the original smears. Results showed that 131 smears contained typical endometrial cells, 24 contained atypical cells, and 33 had cells that were suspicious for carcinoma (cancer). Further examination revealed that 13 patients had hyperplasia (benign increase in cell number); 31 had endometrial cancer or another type of malignancy; and 7 had endometrial polyps (nonmalignant growths). Details regarding patient age, drug regimens, and other characteristics are presented. Fourteen of the women who had cancer also had vaginal bleeding when the smear was taken; the remainder did not have symptoms. Endometrial cells were found in Pap smears during the latter phase of the cycle, or in postmenopausal women, at a rate of 1/900. Patients in these categories with endometrial cells in their smears should be evaluated intensively, even if the cells appear normal (Fifteen percent of the patients in this study had normal cells with endometrial disease). A classification system for endometrial cytology is presented. (Consumer Summary produced by Reliance Medical Information, Inc.)

The significance of moderate and severe inflammation on class I Papanicolaou smear

Article Abstract:

Patients with a class I (normal) Papanicolaou smear (Pap smear), a test used to evaluate the cells of the female sex organs to detect cancer, may also have signs of inflammation. The significance of inflammation in class I smears has not been systematically studied. To learn more about this type of finding, a retrospective study was carried out of microscopic slides prepared from the cervical region of 596 women. The percentages of slides that fell into standard Papanicolaou diagnostic classes (I through V) were within normal limits, and patients with moderate or severe inflammation were asked to undergo colposcopy, examination of vaginal and cervical tissue with a magnifying lens. Results showed that 106 of the 540 class I smears had inflammatory changes; 78 of these women returned for colposcopy. The findings for 19 women (24 percent) were normal. The rest underwent cervical biopsy and other diagnostic methods as needed. Twenty-two patients had koilocytotic atypia (an abnormal cell type) or condylomata (genital warts), changes known to be associated with infection by human papillomavirus (HPV). Nine more had cervical intraepithelial neoplasia, a type of cellular change in which large numbers of abnormal cells appear; this can be a forerunner to cancer. Thus, slightly more than half the patients who underwent biopsies had positive results. Under normal clinical circumstances, patients with inflammatory changes, but with normal Pap smears, would not have undergone colposcopy. These results suggest that such an examination is indicated for patients with moderate-to-severe inflammation accompanying a class I Papanicolaou smear. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnancy following conservative surgery and adjunctive chemotherapy for stage III immature teratoma of the ovary

Article Abstract:

After having undergone chemotherapy and conservative surgery to treat a malignant growth in her ovary, a 24-year old woman was able to become pregnant and delivered a full term infant. The woman was treated with anticancer drugs, such as vincristine, for immature teratoma of the ovary, a malignant growth made up of different types of tissue, none of which is native to the area in which it occurs. This is the first reported case of a successful pregnancy after having had advanced-stage immature teratoma.